| NPI | 1659486587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 12664) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 21857) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2014-01-03 |